PERIOPERATIVE RISK Assessment and Improvement

1. PERIOPERATIVE RISK
Assessment and Improvement
Anwer Ghani
FIBMS
Iraq

2. The goals
The goals of preoperative assessment
(1) Reduce the morbidity associated with surgery.
(2) Increase the quality of perioperative care.
(3) Decrease the cost.

3. Systematic Assessment
The Role of History (Hx)
The Role of Physical Examination (Ex)
History and examination are very important in perioperative risk assessment.
The Role of Investigations (Ix)
The Role of Diagnosis (Dx)
The surgery, the cardiac disease, the frailty and the comorbidity are very important factors in perioperative risk.
Conclusions

4. Hx
General Hx:
Specific Hx:
Hx of bleeding disorder:
Hx of a problem with wound healing:
Hx of anticoagulants, anti-angina drugs:
Hx of Allergies:
Hx of Active cardiac disease:

5. Hx
Hx Hx of specific risk factors
□Arrhyth
□HRT
□CAD
□Heart D
□COPD
□Asthma
□thromb.

6. Hx
Hx of bleeding disorder
-a clotting disorder?
-nosebleed for no apparent reason?
-bruises under the skin for no apparent reason?
-bleeding into the joints?
-prolonged bleeding after a cut?
-unusually intense bleeding during an operation?
- unusually intense menstruation?

7. Ex
Upper respiratory pathway:
Heart:
Lungs:
Cardiopulmonary reserve:
Potential signs of heart failure:

8. Ex
. MET

9. Hx & Ex
If the initial evaluation (Hx & Ex) yields no evidence of any
conditions significantly affecting the perioperative risk, then, as a
rule, no further testing is needed.

10. Ix
►: Routine
►Hb: ►WBCC: ► Plat:
►RBS: ►BU: ► Scr:
►ECG
The value of a routine preoperative ECG is not yet fully clear.

11. Ix
□: On indication
□CXR: □PFT:
□Echo.: □U/S:
□ Another test:

12. Ix
-There is no reason to perform laboratory testing routinely in all cases.
-There is no correlation between the number of abnormal laboratory findings and the
outcome of surgical treatment.
-Laboratory tests of coagulation should be performed only if indicated by a specific drug
history or a positive bleeding history.

13. Dx
The operation: …….
□ high risk □ low risk
The cardiac disease: …….
□ Uncontrolled □ Controlled

14. Dx
Perioperative risk factors:
 □DM
 □HRT
 □ Coagulopathies
 □Anemia
 □Obesity
 □allergies
 □Old age (frailty)
 □Other Co-morbidity:

15. Dx
Low risk surgery:
-superficial procedures
-endoscopic procedures
-breast surgery
-cataract surgery

16. Dx
Cardiac risk factors
CAD
PAD
CHF
CVA
DM
CRF

17. Dx
 CFS

18. Dx
The strongest predictors of perioperative complications are the patient’s pre-existing
illnesses.

19. The Risk
Predictors of periop. complications:
-Age (Frailty)
- Invasiveness of the procedure,
-History of renal disease
- Anemia
-Abnormal ECG.

20. The Risk
Perioperative risk:
- Active (uncontrolled) Heart disease risk:
- Cardiac risk factor:
- Surgery risk:
- Frailty risk:
- Co-morbidity risk:
Expert Opinion:

21. The Risk
Outcome:
-LOS
-Complications
-Mortality
-Readmission

22. The Risk
The Recommendations:
-Risk assessment and outcome discussion
- Improve the outcome
- Modifying the risk
- Precautions and recommendations
- Pre, intra and post-operative management.
-Interventions and consultations.